October 2017
Volume 38, Issue 10

Q: How can Dental Service Organizations position themselves to better serve the expanding aging population?

James Bramson, DDS; Doug Brown, BS, MBA; Mary Lee Conicella, DMD; Lisa A Stepanian; and Stephen Thorne IV, BA, MHA

Dr. Bramson

Since the “Great Recession” of 2008-2009 the volume of dental services has been significantly impacted. Dental incomes, while dropping during the recession, have been steady now for several years, and the industry is predicted to have modest growth in the foreseeable future.1

One area of dental care delivery that has good growth potential is within the senior population and their expanding dental needs. Demographically, as baby boomers age, there simply are more elderly in America. By 2050, the population aged 65 and over is projected to almost double that of 2012. Baby boomers are largely responsible for this increase, as they began turning 65 in 2011.2

People are living longer, too; one could argue perhaps that 70 is the new 50. Edentulism continues to decrease3 and many seniors are taking fuller dentitions into their later years. Dental service organizations (DSOs) can be a significant resource for serving this growing population for a number of reasons.

Size and pricing—DSOs, including the largest dental firms (ie, 500 or more employees), are growing rapidly in terms of the number of dental establishments owned and/or managed.4 Personal industry sources estimate that about 12% to 15% of the entire dental market is now delivered by large DSOs. DSOs are typically quite strategic in their growth, market positioning, and operational systems beyond what is typically seen in traditional solo or small group dental practices. The sheer distribution and size of some large DSOs could easily lend them to target certain communities or areas that have large elderly populations and uniquely niche their offices in those areas. Also, because of their purchasing power, DSOs often have a greater economy of scale when negotiating for supplies, equipment, and other business overhead expenses. This affords them to be more aggressive with treatment pricing and financing, which for a senior population on a fixed income may be attractive.

Efficiency of operations—Recent American Dental Association studies showed that the percentage of dentists with a perceived workload of “not busy enough” was at about 27% for all dentists.5 A targeted elderly population could help increase the demand for care and conceivably fill some of that empty chair time. Special staffing, equipment, or transportation services for seniors could be more efficiently used and patient flow directed to certain facilities where that special staffing or equipment is located. Seniors could conceivably provide the mid-day scheduling volume that many practices struggle to fill. Also, DSOs, which are usually adept at marketing and optimizing chair time through the full use of ancillary staff, could focus on outreach programs to nursing homes and other senior facilities.

Training—Most DSOs have significant internal continuing education and professional growth training opportunities for their staff and could easily partner with dental schools that have an expanded geriatric dental curriculum. Training the staff to treat a growing elderly clientele would enable employees to gain a more thorough understanding of the overall dental needs of these patients, which in turn would allow the DSO to provide a more targeted service to them. Furthermore, with the growing emphasis on medical–dental integration, chronic disease management, and understanding multiple drug interactions, DSOs could concentrate their treatment expertise within their overall expertise, business strategy, and office operations.

Convenience—Consumer concerns about receiving care from large healthcare retail settings, such as a Walgreens or CVS, appear to be waning. Patients, including seniors, seem to like the transparency and convenience of these retail operations,6 and a DSO large group model fits within this overall changing philosophy.

In conclusion, the delivery of dental healthcare continues to evolve and DSOs appear to be positioned to capture much of the growth that is expected to occur. Aging baby boomers and the senior population will have significant ongoing dental needs and are likely to be a strategic business target for large DSOs.

Mr. Brown

Edentulism rates in the United States are eye-opening, with estimates suggesting that about 178 million Americans are missing at least one tooth, and 35 million of those are completely edentulous in one or both arches.7,8 Understandably, Americans in their 50s, 60s, and beyond represent a disproportionate slice of this group. This patient demographic is accelerating in growth as baby boomers age, exit the workplace, and make appropriate lifestyle changes. Moreover, it presents unique clinical and nonclinical challenges that many dentists feel underequipped to address.

The expansion of affiliates of provider networks of denture and implant services, such as Affordable Dentures & Implants®, into new markets across the United States reflects an opportunity for the dental profession to more fully embrace this expanding population. By delivering a narrow range of tooth replacement services at a national scale, affiliates of large provider networks concentrating on denture and implant services are able to provide high levels of experience and convenience while passing along critical cost savings.

The author’s provider network sought to develop a practice model that addresses this unmet need. Crucial to the success of this model are strategies like a one-to-one practice ownership structure, where a clinician owns and operates 100% of his or her practice. As a result, turnover is low, and experience in extraction, implant surgery, and removable prosthodontics deepens over time. Additionally, every network practice location in this model features an on-site laboratory, where dedicated lab technicians work in tandem with “front of house” clinicians and staff to enable same-day service. This allows older patients, including those with job demands or who are living on a limited income, to benefit from only having to take one or maybe two days off from work. Because denture patients often have to travel significant distances to reach a tooth replacement practice that is not cost-prohibitive, this same-day service can be invaluable.

By limiting their service offerings to extractions, dentures, and sometimes implants, affiliates within the network do not have to staff or absorb costs related to services like hygiene or restorative care. This helps keeps overhead low and also allows fees to be kept low. Older patients often present unique financial and insurance situations that too often prevent them from accepting treatment. Network affiliates, however, typically are able to set fees at or below insurance co-pays and can offer special financing to their patients that facilitates in-demand solutions like implant-supported mandibular overdentures.

Opportunities continue to exist for dental professionals to improve access to unmet needs for senior citizens. One such opportunity is through training and thereby creating more prospects for dental students and emerging professionals to develop clinical skills in implant treatments. Dental support organizations also present a broader opportunity to allow the next generation of dentists to enjoy practice ownership without taking on large amounts of debt. Affiliated practices do not have to front significant business costs themselves, but instead can rely upon service agreements with the dental support organization for nonclinical management services like real estate, marketing, information technology, and staffing.

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